White Salmon hospital is one of many across the state dealing with nurse shortages.

White Salmon's Skyline Hospital is one of many hospitals across the state that are dealing with a shortage of nurses and other key medical personnel.

The problem is severe enough that the Washington State Hospital Association (WSHA) has released a glossy, 74-page report entitled Who Will Care For You? which spotlights the problem and describes ways medical facilities might be able to correct it.

"The issue is serious now, and our efforts to highlight it are a way to avert a crisis that could seriously and adversely impact patient care in the future," said Cassie Sauer, a spokesperson for the Washington State Hospital Association, based in Seattle.

Mike Madden, administrator of Skyline Hospital, said the impact of the nursing shortage is widespread.

Madden noted that there simply have not been enough people going into the nursing field over recent years.

"Especially when the `Dot-coms' were making all the money, people were picking other professions, and not many were settling into nursing," Madden explained. "It's an industry-wide problem, but most acute with RNs (registered nurses)."

Madden said he believes the shortage has gotten worse in the last year.

"We didn't seem to have this many vacancies nationwide a year ago," he said. "But a lot of nurses are retiring or doing something else."

According to Madden, the average nurse in Washington starts out at approximately $16-$18 an hour.

The WSHA report listed several major consequences of the personnel shortages. Among them:

Compromised patient care: Insufficient staff can cause patient care problems because hospitals are relying more on temporary staff who are unfamiliar with policies, procedures, and equipment, and thus the probability they may make mistakes is higher;

Emergency room diversions: Shortages of personnel result in overloaded emergency rooms at some hospitals. This leads to patients being sent elsewhere, which can result in delayed care;

Delayed surgeries: Absence of staff mean hospitals may postpone some surgeries, which can lead to prolonged discomfort and/or increased complications;

Disaster preparedness: Personnel shortages could make it difficult for hospitals to handle many injuries in a major emergency or disaster.

The report points out that the shortage of nurses is likely to get worse before it gets better, because the average age of nurses in Washington is about 45. Fewer than nine percent of nurses are under age 30.

To fill the need, hospitals -- including Skyline -- contract with private temporary nursing providers. However, temporaries end up costing the hospital more than regular employees. Madden estimated that using the temporaries cost the hospital approximately $10-$12 an hour more than what Skyline pays its own nurses, because the firms take a cut for the service they provide.

Janet Holen, a member of the Skyline Hospital Board of Commissioners, said the nursing shortage has a negative financial impact on Skyline.

"It's a huge cost to the hospital, because to use the temporary nurses costs much more," Holen said. "Plus, the hospital has to pay for their lodging. That's money that could be spent other ways."

To ensure adequate staffing, Madden said Skyline is doing "what everybody else is doing." That includes hiring temporaries, and paying premiums to get nurses to come to White Salmon.

Madden said the need for qualified nurses is highest in the intensive care unit. He said the hospital has been forced to give up patients at times because the necessary staff is not in place.

"When doctors want to put a patient in ICU and we don't have the nurses for that, we have to transfer the patient," Madden explained.

"If we can't properly staff, then we have to divert patients to another hospital and lose that revenue," added Holen.

Holen said the profession has suffered in recent years, and public perceptions need to be changed.

"It's not seen as a profession to go into, because there are so many other options," she said. "It's hard work, and the pay is OK, but is much higher in high-tech fields, for example. Our society needs to somehow elevate the profession in people's minds."